2 Prior Authorization Processes, 1 Patient: What Blood Cancer Reveals About Your EHR Workflow

Someone in the United States is diagnosed with a blood cancer roughly every three minutes. Blood Cancer United (formerly the Leukemia & Lymphoma Society) estimates 1.6 million people are living with or in remission from leukemia, lymphoma, myeloma, and related conditions. That’s enough to fill 25 NFL stadiums. 

Blood Cancer Awareness Month celebrates the development of innovative new treatments and a decade of therapeutic progress that has benefited patients. Unfortunately, the prior authorization (PA) process that determines if or when treatment can start hasn’t kept pace. As with other complex and chronic diseases, blood cancer care is often delayed by a fragmented, manual PA workflow.

How does the current prior authorization process impact access to prescribed therapies? For EHR vendors, it’s important to understand where delays are happening and what can be done to improve the experience for healthcare providers and their patients.

Treatment requires both pharmacy and medical prior authorization

Medications for many conditions are covered by either pharmacy or medical benefits. Blood cancer usually requires both.

For example, a patient may be prescribed an oral targeted therapy that’s covered by his or her pharmacy benefit, is dispensed by a specialty pharmacy, adjudicated by a PBM, and authorized under a certain set of rules. The same patient may also need to receive a different medication at an infusion center, which is covered by the medical benefit (Medicare Part B or a commercial plan), and uses an entirely different prior authorization process, web portal, and reviewer.

Other types of care involve the same split. Erythropoiesis-stimulating agents (ESAs), for instance, are used for anemia in patients with a type of blood cancer called myelodysplastic syndromes (MDS). ESAs are given as an injection at an infusion center and billed under medical benefits with the drug on one line and the center’s nursing and facility fees on another.

The administrative burden of separate prior authorizations for medications and medical procedures spans multiple prescribers. A bone marrow biopsy goes through one team, while molecular and cytogenetic panels run through the lab. A hematologist-oncologist manages therapy while a transplant or cellular therapy team and palliative care each authorize their own part of treatment.

For a single patient’s care plan, there are multiple PA requesters, two benefit pathways, and a multitude of chances for the schedule to slip and treatment to be delayed.

Why prior authorization takes so long

Three factors determine whether the prior authorization process takes days or weeks:

Documentation density. Clinical notes, diagnosis codes, imaging, lab results, and letters of medical necessity must all be assembled and submitted. When a detail is missing, the request cycles back, causing rework for the practice and a second pass for the payer.

Repeat authorizations. Patients with MDS may stay on ESAs for years, requiring re-authorization every calendar year, on a change of physician, insurance plan, or formulary, or when a patient winters elsewhere and sees a seasonal provider in a different state. Each re-authorization can cause delays for patients who typically follow a carefully orchestrated cadence of infusions or injections.

The appeal loop. The average age of blood cancer patients at diagnosis falls between 60 and 70, which means many are covered under Medicare Advantage. KFF’s analysis of 2025 payer data covers MA prior authorization across all conditions and services, not oncology specifically, but it shows what happens once a request is denied. Plans denied 12% of non-expedited requests, then reversed 67% of the denials that were appealed. Two in three reversals say the first submission, not the therapy, was the problem. And most denials are never appealed at all, which means more patients would likely have gotten an approval had someone kept pushing.

An ASCO survey found half of patients needing a prior authorization ended up making the calls and chasing approvals themselves, and 80% of oncology providers say they have watched a patient’s disease progress while the paperwork stalled. Policy is addressing these delays, but it’s moving slowly. CMS-0057-F holds impacted payers to seven calendar days for standard decisions, but excludes decisions for drugs, which is often where blood cancer patients wait.

How the prior authorization process works within your EHR workflow

The AMA’s 2025 survey found that physicians and staff spend an average of 13 hours a week on prior authorization, across roughly 40 requests. Here’s what that means within the EHR workflow:

• Staff leave the chart to work on PAs in separate portals, each with its own login and question format.
• The same clinical facts get re-entered manually across pharmacy and medical requests, because information doesn’t carry through between them.
• Documents get uploaded, faxed, and re-uploaded, and status doesn’t appear in the patient’s chart, leaving schedulers to book infusions and other treatments blind.

Unifying and automating the prior authorization process

Much of what a payer’s PA question set asks for already exists in the prescribing workflow: patient demographics, medication history, diagnosis, and the prescription itself. Yet the workflow requires the prescriber to re-enter that data for the PA.

The DrFirst ePA solution automates the transcription work by applying clinical-grade AI to populate answers to payer question sets. It also unifies pharmacy and medical prior authorization in one workflow with no document uploads. In a recent one-month pilot, it auto-answered more than 2 million payer questions across 150,000 PAs with the following results:

• 63% of payer question sets were populated with no clinician edits
• Over 90% of payer question sets were populated after the clinician answered a single qualitative question
• 49 seconds was the median time from open to submit

A submission that arrives complete the first time is easier for a payer to review and may never enter the appeal loop at all.

How much time do your EHR clients spend on a disconnected PA process?

When providers using your platform can complete PAs in under a minute, within the chart, and across both benefits, they can reduce time from clinical decision to first dose, reclaim staff hours, and book treatment appointments that hold.

Prior authorization approval shouldn’t be the reason patients wait for the advanced therapies available today. This Blood Cancer Awareness Month, consider how closing gaps in your EHR workflow can also close treatment gaps that delay access to care.

Learn More About DrFirst ePA